Anaphylaxis to rocuronium

Abstract

AnaesthesiaVolume 58, Issue 2 p. 196-196 Free Access Anaphylaxis to rocuronium First published: 23 September 2008 https://doi.org/10.1046/j.1365-2044.2003.03005_20.xCitations: 6AboutSectionsPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat We present this case in response to recent recommendations [1] that cases of anaphylaxis to rocuronium should be fully reported. A 47-year-old, ASA II woman presented for elective gynaecological surgery. Her past medical history included a prior admission to the intensive care unit following an allergic reaction to iodine contrast media. Previous general anaesthesia had been uneventful. Anaesthesia was induced with fentanyl, propofol (containing 1% lidocaine) and rocuronium. Intubation was uneventful, but within 5 min, an allergic reaction was diagnosed on the basis of bronchospasm, tachycardia (150 bpm), severe hypotension (60/30 mmHg) and the development of a widespread, florid and erythematous rash. She was given epinephrine 100 µg and 1 L of crystalloid intravenously. The situation improved rapidly with a return to baseline of cardiovascular parameters and improved lung compliance. Whilst recovery from neuromuscular block was awaited, a discussion was held with the surgeon and senior anaesthetic colleagues. Surgery was postponed, as the intended procedure could have involved significant blood loss. She was extubated 1 h post induction, once neuromuscular function had returned to normal. As a precaution she was admitted to a high dependency area overnight. She recovered fully and ultimately elected not to have surgery. Anaphylaxis was confirmed by elevated serum tryptase of 65 nmol.ml−1 1 h after the reaction. Skin prick testing 2 months after the event identified rocuronium as the causative agent (1/10 diluted solution). Interestingly, she also demonstrated sensitivity to succinylcholine, vecuronium and morphine (1/10 diluted solutions). Yellow card reporting was undertaken, the patient was counselled by the anaesthetic assessment clinic and MedicAlert warnings obtained. We agree with Baillard [1] and others that close monitoring of drug-related adverse events is desirable, but stress that all drugs are included in such a process. Unless this precaution is taken, reporting bias may over-exaggerate the dangers of one particular drug (as may well be occurring presently with rocuronium). The determination of the anaphylaxis risk of a drug is difficult as neither the numerator nor denominator are accurately known: Adverse events are known to be under-reported [2], and little information exists as to how many patients have been exposed to any one drug. R. ThomasM. Wood Queen Alexandra Hospital, Portsmouth PO6 3LY, UK References 1 Baillard C, Korinek AM, Galanton V, Le Manach Y, Larmignat P, Cupa M, Samama CM. Anaphylaxis to rocuronium. British Journal of Anaesthesia 2002; 88: 600 – 2.CrossrefCASPubMedWeb of Science®Google Scholar 2 Jayasuriya JP, Anandaciva S. Compliance with an incident report scheme in anaesthesia. Anaesthesia 1995; 50: 846 – 9.Wiley Online LibraryCASPubMedWeb of Science®Google Scholar Citing Literature Volume58, Issue2February 2003Pages 196-196 ReferencesRelatedInformation